OBJECTIVES: To evaluate the efficacy and tolerability of a single dose of oral cefixime 800 mg plus oral doxycycline 100 mg twice a day for 7 days, compared with a recommended single dose of ceftriaxone plus single dose of oral azithromycin, for treatment of uncomplicated urogenital, rectal, or pharyngeal gonorrhoea. METHODS: A noninferiority, open-label, multicentre randomized controlled trial was conducted in Prague, Czech Republic. Some 161 patients, 18-65 years of age diagnosed with uncomplicated urogenital, rectal, or pharyngeal gonorrhoea by nucleic acid amplification test (NAAT) were randomized to treatment with single dose of cefixime 800 mg plus doxycycline 100 mg twice a day for 1 week or a single dose of ceftriaxone 1 g intramuscularly plus single dose of azithromycin 2 g. The primary outcome was the number of participants with negative culture and NAAT at 1 week and 3 weeks, respectively, after treatment initiation. RESULTS: In all, 161 patients were randomized and 152 were included in per-protocol analyses. All 76 (100%; 95% CI, 0.95-1.00) patients treated with ceftriaxone plus azithromycin achieved negative cultures and NAAT after treatment. In the cefixime plus doxycycline arm at week 1, culture was negative in all 76 (100%) patients; at week 3, culture was negative in 70 of the 76 patients (92%; 95% CI, 0.84-0.97) and NAAT negative in 66 of the 76 patients (87%; 95% CI, 0.77-0.94). At week 3, culture and NAAT were negative in 65 of the 76 patients (86%; 95% CI, 0.76-0.93). Per-protocol risk difference was 14.5%; 95% CI, 6.56-22.38. All treatment failures observed in the cefixime arm were pharyngeal gonorrhoea cases. DISCUSSION: The combination of cefixime and doxycycline did not achieve noninferiority to ceftriaxone and azithromycin for treatment of gonorrhoea when including pharyngeal gonorrhoea. It did, however, show high efficacy for urogenital and rectal gonorrhoea.

• Klíčová slova
• Azithromycin, Cefixime, Ceftriaxone, Doxycycline, Neisseria gonorrhoeae, Treatment,
• MeSH
• antibakteriální látky terapeutické užití   MeSH
• azithromycin terapeutické užití   MeSH
• cefixim terapeutické užití   MeSH
• ceftriaxon * MeSH
• dospělí MeSH
• doxycyklin terapeutické užití   MeSH
• gonorea * farmakoterapie   mikrobiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• Neisseria gonorrhoeae MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• hodnocení ekvivalence MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• antibakteriální látky MeSH
• azithromycin MeSH
• cefixim MeSH
• ceftriaxon * MeSH
• doxycyklin MeSH

• Klíčová slova
• COVID-19, gonorrhea, syphilis,
• MeSH
• COVID-19 * epidemiologie   MeSH
• gonorea * epidemiologie   MeSH
• lidé MeSH
• pandemie MeSH
• syfilis * epidemiologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• dopisy MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

• MeSH
• antibakteriální látky MeSH
• azithromycin * MeSH
• ceftriaxon MeSH
• gentamiciny MeSH
• gonorea * MeSH
• lidé MeSH
• Neisseria gonorrhoeae MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• dopisy MeSH
• komentáře MeSH
• Názvy látek
• antibakteriální látky MeSH
• azithromycin * MeSH
• ceftriaxon MeSH
• gentamiciny MeSH

OBJECTIVES: The aim was to evaluate the efficacy and tolerability of gentamicin 240 mg plus azithromycin 2 g for treatment of uncomplicated rectal and pharyngeal gonorrhoea compared to ceftriaxone 500 mg plus azithromycin 2 g, the recommended European first-line gonorrhoea treatment. METHODS: A non-inferiority, open-label, single-centre randomized controlled trial was conducted in Prague, Czech Republic. Patients, 18-75 years of age, diagnosed with uncomplicated rectal or pharyngeal gonorrhoea by nucleic acid amplification test (NAAT) were randomized to treatment with gentamicin 240 mg intramuscularly plus azithromycin 2 g orally or ceftriaxone 500 g intramuscularly plus azithromycin 2 g orally. The primary outcome was negative culture and negative NAAT, i.e. 1 week and 3 weeks, respectively, after treatment. RESULTS: Both clinical cure and microbiological clearance was achieved by 100% (95% CI 0.95-1.00) of patients in the gentamicin/azithromycin arm (n = 72; 40 rectal, 17 pharyngeal and 15 rectal+pharyngeal infections both localizations) and 100% (95% CI 0.95-1.00) in ceftriaxone/azithromycin arm (n = 71; 38 rectal, 14 pharyngeal and 19 rectal+pharyngeal infections). The absolute difference between the two arms was 0.0% (CI95% -5.1 to 5.1), thus less than the pre-specified margin of 7%. Administration of gentamicin was not more painful than ceftriaxone according to the visual analogue scale (1.8 vs. 3.4; p <0.001). Gastrointestinal adverse events were similar in the ceftriaxone arm (33/71, 46.5%) and the gentamicin arm (29/72, 40.3%), and overall in most (52/62, 83.9%) cases they were mild. CONCLUSIONS: Gentamicin 240 mg plus azithromycin 2 g is an effective alternative for treatment of extragenital gonorrhoea.

• Klíčová slova
• Azithromycin, Ceftriaxone, Gentamicin, Neisseria gonorrhoeae, Treatment,
• MeSH
• antibakteriální látky aplikace a dávkování   škodlivé účinky   MeSH
• aplikace orální MeSH
• azithromycin aplikace a dávkování   škodlivé účinky   MeSH
• ceftriaxon aplikace a dávkování   škodlivé účinky   MeSH
• dospělí MeSH
• farynx mikrobiologie   MeSH
• gentamiciny aplikace a dávkování   škodlivé účinky   MeSH
• gonorea farmakoterapie   MeSH
• injekce intramuskulární MeSH
• kombinovaná farmakoterapie MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• rektum mikrobiologie   MeSH
• senioři MeSH
• výsledek terapie MeSH
• vztah mezi dávkou a účinkem léčiva MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• antibakteriální látky MeSH
• azithromycin MeSH
• ceftriaxon MeSH
• gentamiciny MeSH

OBJECTIVES: The aim of the study was to determine the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae co-infections among patients with newly diagnosed syphilis. METHODS: In patients with any stage of newly diagnosed syphilis swabs were performed from urethra, rectum, pharynx and cervix according to the gender and type of sexual intercourse. From these smears standard validated nucleic acid amplification tests (NAATs) for Chlamydia trachomatis and Neisseria gonorrhoeae infections were done. RESULTS: From 548 (488 men, 60 women) screened patients co-infection was detected in 15.9% of the cases. The majority of the co-infections (86.2%) were asymptomatic. The overall prevalence of chlamydial infection was 11.1% and 8.8% for gonococcal infections. In men who have sex with men (MSM) the prevalence of co-infections was significantly higher (20.0%) than in heterosexual men and women (4.2%) (p < 0.001). In MSM patients the presence of co-infection was significantly associated with HIV infection (p < 0.001). Among MSM 9.6% of the tests detected infection in anorectal site, while prevalence in urethral (2.8%) and pharyngeal (2.4%) localization was significantly lower. In heterosexual patients prevalence was less than 2.0% in all anatomic sites. CONCLUSIONS: The implementation of screening tests in case of sexually transmitted infections in patients with newly diagnosed syphilis is an important part in the management of this disease. These results suggest that screening of asymptomatic heterosexual patients leads to detection of minimum co-infections, but in MSM (especially HIV positive) should always be performed at least in anorectal site, where asymptomatic co-infections are common.

• Klíčová slova
• MSM, chlamydia, gonorrhea, screening, syphilis,
• MeSH
• Chlamydia trachomatis izolace a purifikace   MeSH
• chlamydiové infekce epidemiologie   MeSH
• gonorea epidemiologie   MeSH
• HIV infekce epidemiologie   MeSH
• homosexualita mužská statistika a číselné údaje   MeSH
• koinfekce MeSH
• lidé MeSH
• Neisseria gonorrhoeae izolace a purifikace   MeSH
• prevalence MeSH
• průřezové studie MeSH
• syfilis diagnóza   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Recent years have seen rising concerns over increasing antibiotic resistance of the gonorrhea-causing bacterium, Neisseria gonorrhoeae. This is especially true for third-generation cephalosporins, which are currently recommended for the treatment of such infections. Therefore, susceptibility to these antibiotics should be monitored internationally to the greatest extent possible. The susceptibility of N. gonorrhoeae strains to ceftriaxone and penicillin, as well as production of beta-lactamase by the Cefinase test was determined. Moreover, the presence and type of penicillinase plasmids were determined by PCR. All strains were susceptible to ceftriaxone, the minimal inhibitory concentration (MIC) values ranged from 0.002 to 0.125 mg/L; MIC50 was =0.016 mg/L and MIC90 was =0.064 mg/L. As much as 7.7 % of the strains demonstrated ceftriaxone MIC of 0.125 mg/L. For penicillin, the MICs ranged from 0.064 to 32 mg/L; MIC50 was =0.5 mg/L and MIC90 was =4 mg/L. It was shown that only 1.5 % of the strains were sensitive to penicillin according to The European Committee on Antimicrobial Susceptibility Testing (EUCAST). Among the penicillin-resistant strains, six (30.0 %) produced penicillinase. The MICs of penicillin were substantially higher for penicillinase-producing than for penicillin-resistant, penicillinase-negative strains. MICs of ceftriaxone for penicillinase-producing strains were low (0.002-0.016 mg/L). Three of the penicillinase-producing strains possessed plasmids of African type (50 %) and three Toronto/Rio type (50 %). An increase of the proportion of beta-lactamase-positive strains in the last years as well as emergence of strains with elevated MIC of ceftriaxone indicate a need to constantly monitor N. gonorrhoeae strains for their susceptibility to beta-lactam antibiotics, as well as for their ability to produce beta-lactamases.

• MeSH
• antibakteriální látky farmakologie   MeSH
• cefalosporiny metabolismus   MeSH
• ceftriaxon farmakologie   MeSH
• gonorea mikrobiologie   MeSH
• lidé MeSH
• mikrobiální testy citlivosti MeSH
• Neisseria gonorrhoeae účinky léků   genetika   izolace a purifikace   MeSH
• penicilinasa metabolismus   MeSH
• peniciliny farmakologie   MeSH
• plazmidy analýza   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Polsko MeSH
• Názvy látek
• antibakteriální látky MeSH
• cefalosporiny MeSH
• ceftriaxon MeSH
• nitrocefin MeSH Prohlížeč
• penicilinasa MeSH
• peniciliny MeSH

The epidemiology of selected sexually transmitted diseases in the Czech Republic has been carefully evaluated for many years. Data from 1981-2011 for eastern Bohemia shows a sharp decrease in the incidence of gonorrhea in 1993-1994 and a very low incidence thereafter with a slightly higher prevalence in males. However, syphilis and genitourinary infections with Chlamydia trachomatis show entirely opposite trends. Also, for the similar number of diagnostic tests performed, Chlamydia had a 10 fold higher rate of positive results. This underscores the changing epidemiology of sexually transmitted infections (STI) and necessity for adapting the reporting algorithms accordingly.

• MeSH
• chlamydiové infekce epidemiologie   MeSH
• gonorea epidemiologie   MeSH
• incidence MeSH
• lidé MeSH
• prevalence MeSH
• syfilis epidemiologie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

• MeSH
• Chlamydia trachomatis * MeSH
• chlamydiové infekce * diagnóza   prevence a kontrola   přenos   MeSH
• Chlamydophila pneumoniae * MeSH
• gonorea * diagnóza   prevence a kontrola   přenos   MeSH
• infekce bakteriemi rodu Chlamydophila * diagnóza   prevence a kontrola   přenos   MeSH
• infekční komplikace v těhotenství * diagnóza   MeSH
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• vertikální přenos infekce MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Gonococcal infection in the postantibiotic era continues to cause disseminated and severe disease in some patients. The differential diagnosis of pain in the lower abdomen in young women is difficult. Our case report described a 19-year-old patient who presented with acute abdomen as a result of Gonococcal infection, assessed as a local complication, pelveoperitonitis: pelvic inflammatory disease. The message of our case report is sexually transmitted infections should invariably be considered in young women and searched for accordingly.

• MeSH
• akutní bolest břicha mikrobiologie   MeSH
• dospělí MeSH
• gonorea komplikace   diagnóza   MeSH
• lidé MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH

INTRODUCTION: A large increase in syphilis prevalence was noted in the Czech Republic during the last decade. It was associated with prostitution in cities and especially in areas bordering more economically developed countries. Foreigners account for more than 50% of this increase. Absence of legislative regulations contributes to this situation. OBJECTIVE: To demonstrate the necessity of setting sexually transmitted disease (STD) fighting priority in the Czech Republic. METHODS: The authors review the development of legislation related to STDs in the context of geopolitical changes and the epidemiological situation in the Czech Republic by relating epidemiological, geopolitical and economic data. RESULTS: Venereal-diseases-related regulatory codes have existed in the Czech Republic for years; however, they became fragmented in several regulations and often do not have the status of law. It is a consequence of the transformation of the entire state health care delivery system to a private system. The treatment of foreigners, refugees and uninsured people is a major problem. CONCLUSION: It is necessary to focus on special populations, such as homeless people, immigrants and prostitutes. It is desirable to strengthen international cooperation in combating STD as well as prostitution. Relevant legislation should be introduced to correlate the existing regulations and bring them up to date.

• MeSH
• gonorea epidemiologie   MeSH
• lidé MeSH
• prevalence MeSH
• prostituce zákonodárství a právo   statistika a číselné údaje   MeSH
• sexuálně přenosné nemoci epidemiologie   MeSH
• syfilis epidemiologie   MeSH
• veřejné zdravotnictví zákonodárství a právo   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH